DCH-i [Vol. 1, no. 9 (July 2012)]

Georgia Department of Community Health

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Home DCH-i July 2012 Vol. 1 Issue 9
DCH-i July 2012 Vol. 1 Issue 9

About DCH-i

In This Issue
Medicaid Redesign: We're Just Getting Started
Medicaid and CHIP Redesign Moves Forward

DCH-i is the monthly newsletter from the Georgia Department of Community Health for all matters DCH. It provides timely and important information to you as physicians, dentists, hospitals, third-party payers, vendors, health care advocates, consumers and legislators. Our goal is to help create A Healthy Georgia -- together. Write us at DCH-i@dch.ga.gov.
From the Commissioner
Medicaid Redesign: We're Just Getting Started

Improved Patient Care, Reduced Provider Administration
Task Forces, Workgroups Ideas Invaluable
Questions Others Have Asked
A Look Back -- How We Arrived at Our Decision
The View Ahead -- Coming into Focus

The Medicaid Redesign process has been an important undertaking for the Department of Community Health (DCH) during the past 12 months. Last week, thanks to the work of DCH staff and the contributions of stakeholders through our task forces and workgroups, we were able to announce several key initiatives to improve Georgia's Medicaid program. This special edition of DCH-i will highlight many of them.

David A. Cook

I am most proud of our plan to

transition children in foster care to a

care management vendor. This

improvement will offer greater continuity of care to this vulnerable

population who frequently change residences.

Do you have a question or a comment? Tell us what's on your mind at DCH-i@dch.ga.gov.
About DCH

Because of the increasing uncertainty at the federal level, we determined that a complete restructuring of the Medicaid program would be imprudent at this time. Instead, we will continue to collaborate with stakeholders, and when we see an opportunity that makes sense we will take advantage of it.
The redesign process has been very beneficial and valuable for the department. We have been able to take a comprehensive look at our current options, weigh recommendations and hear from those who will be affected. That will all continue.
A number of people have devoted a great deal of hard work to produce innovative ideas that we will implement. We could not have done this without their active participation. We look forward to continuing that collaboration as we move forward toward A Healthy Georgia.

David A. Cook, Commissioner

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Medicaid and CHIP Redesign Moves Forward

Through effective planning, purchasing and oversight, the Department of Community Health (DCH) provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and underserved populations.

The Georgia Department of Community Health (DCH) will move forward with implementing key recommendations from its Medicaid and CHIP (Children's Health Insurance Program/PeachCare for Kids) Redesign task forces and workgroups. It will not, however, pursue wholesale restructuring of Georgia's Medicaid program at this time because of increasing uncertainty at the federal level.

DCH is responsible for Medicaid and PeachCare for Kids, the State Health Benefit Plan, Healthcare Facility Regulation and Health Information Technology in Georgia.
David A. Cook is the DCH Commissioner.
We are dedicated to A Healthy Georgia.
www.dch.georgia.gov

"I am very pleased with the process we have used during this redesign initiative," said David A. Cook, commissioner of the Georgia Department of Community Health. "As a result of our efforts, we will implement numerous initiatives to improve services in a cost-effective manner."
The department will continue using a care management organization (CMO) to serve the Low-Income Medicaid and PeachCare for Kids populations in a full risk-based managed care environment, incorporating improvements and ideas received from stakeholders. The Aged, Blind and Disabled populations will continue to be enrolled in fee-for-services care.
After months of in-depth analysis, the department concluded that the current health care environment is so volatile that acting now with a full redesign would not serve the best interests of all Georgians.

Editor-in-Chief Pamela A. Keene
Graphic Design Karen Rothschild
Webmaster Jeffrey L. Holt
Production Iris McIlvaine
Circulation Denise Smith

"The redesign process has allowed us to start a meaningful dialogue with the health care community, take a comprehensive look at options, receive recommendations on improvements, and solicit feedback on numerous ideas. We will continue the process as we look at more ways to improve Georgia's Medicaid program," Cook said.
As part of the redesign, the department will implement these program changes and enhancements:
Foster Children will be transitioned to a care management vendor to achieve greater continuity of care for this special population. This will also help with the Georgia Division of Family and Children's Services (DFCS) federal requirements to assure that this vulnerable population receives ongoing medical care in the all-too-often transient setting in which they live.

Deputy Director Communications Peggy Woodruff
Director Communications Christopher Schrimpf
DCH Mission
The mission of the Department of Community Health is to provide access to affordable, quality health care to Georgians through effective planning, purchasing, and oversight.
We are dedicated to A Healthy Georgia.
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Value-based Purchasing will be adopted to continuously improve the quality of care for members while enhancing value. Value-based purchasing will also better engage providers in health outcomes and save money for Georgia's taxpayers.
Provider Web Portal will reduce administrative burdens and make it easier for providers to serve their patients. This centralized web portal will include patient information to help providers more effectively serve their patients across all plans. Tied to our Medicaid Management Information System (MMIS), and driven by claims activity, this portal will serve as a bridge to electronic health records (EHR) technology before EHRs are fully adopted within Georgia. Providers will be able to submit prior authorization and precertification requests electronically. The system will also offer physicians and providers a way to compare their patient outcomes with those of their peers.
Common Pharmacy Preferred Drug List will be created for certain therapeutic categories to simplify the pharmacy program and reduce administrative burdens on providers.
Home- and Community-based Services will move forward with rebalancing initiatives to encourage the delivery of patient care to home- and community-based settings rather than skilled nursing facilities. DCH recently received a three-year $57 million federal grant to expand its Home- and Community-based Services rebalancing initiatives.

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Improved Patient Care, Reduced Provider Administration

With more administrative simplification for providers and improved access to health care for members, the steps that the Georgia Department of Community Health (DCH) is taking to enhance Medicaid and PeachCare for Kids programs will be far-reaching.
"We listened to stakeholders and implemented areas that they saw as priorities," said DCH Commissioner David A. Cook. "We seized the chance to enhance Georgia Medicaid particularly when these ideas presented opportunities for improvements in health outcomes and reduced administrative burdens."
A number of excellent ideas and alternatives were presented to make Medicaid better for members, providers and all Georgians.
"Providers will experience more administrative simplification, with the use of the one-stop web portal that will streamline business processes and deliver better information to the providers about the patients they serve," said Jerry Dubberly, Pharm.D., chief of Georgia Medicaid. "Additionally, the department will seek better care outcomes and greater access to care for our members. We're also asking patients to become more engaged with their health care to achieve better health outcomes."
Georgia Medicaid will continue to serve Georgia Families members through at-risk managed care. Members of the Aged, Blind and Disabled populations will retain fee-for-service (FFS) coverage. The state now has a strong foundation of recommendations, data, and stakeholder perspectives that will allow DCH to modify and improve the existing FFS program to better manage costs and improve outcomes outside of structural changes to the program.
"Improvements to Georgia Medicaid will be an ongoing process," Dubberly said. "We will continue to seek opportunities for better health outcomes, reduced administrative burdens for providers and greater accountability from both providers and patients."
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Task Forces, Workgroups Ideas Invaluable

Once the Navigant Design Strategy Report was released, it was important to dig deeper into core issues and opportunities. To do this, DCH formed three task forces -- Aged, Blind and Disabled; Children and Families; and Providers. Additionally, a special workgroup on Mental Health and Substance Abuse came together.
"By hearing from advocates, physicians, health care providers, public officials and others, DCH was able to move forward in the most effective way possible in light of the uncertainty in Washington," said DCH Commissioner David A. Cook. "Each member's contribution weighed heavily in our decision making, and we are very grateful for the time and comments these stakeholders shared with us. Because this dialogue has been so meaningful, these groups will continue meeting throughout the remainder of the process."
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Questions Others Have Asked

Why did DCH decide to postpone the redesign decision and is there a timeline for this postponement? The redesign process has been enormously beneficial to the Department of Community Health (DCH) and the redesign process will continue. As a result, we will implement numerous changes that will lead to improved quality of care and coordinated care, as well as reduced costs and administrative simplification.
A great deal of uncertainty at the federal level affected our decision to delay major structural changes in Medicaid. We deemed that a wholesale overhaul of the program did not make sense and would not be responsible for us to undertake at this time. That said, we will move forward in several areas that do make good sense. The redesign process is ongoing. Our stakeholders have asked us to go slowly, implement improvements where possible and build on successes. We agree.
What were the federal factors impacting the redesign decision? Some of the major factors include dozens of questions about the opt in/opt out of the Medicaid expansion provision of the ACA, the November elections, the possibility of ACA-related waivers, the possibility of a block grant system, ongoing federal budget negotiations, and potential loss of the federal Upper Payment Limit funds to the state if the state chose to increase the use of managed care.
What parts of the redesign are being implemented? For CMOmanaged populations, we will build in the principles of Value-based Purchasing into future contracts; continue to improve quality outcomes and coordinated care; and make Georgia Medicaid a more attractive payer for providers. For Aged, Blind and Disabled (ABD) populations, we will work within the existing DCH-led administrative structure to improve outcomes and incentivize quality care; maximize Home- and Community-based Services (HCBS) to provide better and lower cost of care; identify key drivers of cost (such as hospital readmissions within 30 days) and implement strategies for improvement; maintain our collaboration with ABD Task Force members and build on those relationships.
In addition, we will move all foster children from fee-for-service into a care management vendor to enhance their continuity of care; develop a new web portal for providers to reduce administrative burdens and make it easier to care for patients; and establish a Common Pharmacy Preferred Drug List (PDL) for selected therapeutic classes of drugs.
When we see additional opportunities that make sense, we will act on those as well.
Why was the ABD population left out of these initial implementations? This population was not left out as we have stated here. The learning from the entire redesign process, including the excellent work done by our task force and workgroup members, will be used to benefit the ABD population as we look at new options moving forward.
How did the U.S. Supreme Court decision on the Medicaid expansion population impact the redesign decision? The court's ruling on the Medicaid expansion population was unexpected. While it provides some flexibility for the states, it also adds significant uncertainty and raises important questions that need to be answered.
With all the uncertainty and delay, will Georgia opt out of the ACA's Medicaid expansion provision? Georgia has not made a decision on that option and is not expected to do so until after November.
Was the redesign process a good use of taxpayer dollars? Absolutely. We are already reaping benefits from the redesign by building Value-based Purchasing models and making administrative simplification improvements. The redesign process will result in better health outcomes, reduced costs and simplified administration. In addition, the redesign process has been a catalyst for positive change and candid communications with stakeholders. Bottom line, the redesign process has been invaluable to the department.
Why was the Medicaid redesign needed in the first place? We wanted to learn what was working well, what could be improved ... what was driving access, quality of care and costs ... and how we could better serve Medicaid patients, providers and Georgia taxpayers. The process and approach have been positive, inclusive and extremely beneficial.
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A Look Back How We Arrived at Our Decision

assist with the redesign.

Slightly more than one year ago, the Georgia Department of Community Health (DCH) began the process for a redesign of Medicaid and the Children's Health Insurance Program (CHIP/PeachCare for Kids). Navigant Consulting Inc. was contracted to

In the fall of 2011, DCH held 30 stakeholder focus groups around the state hearing from patients, advocates, physicians, hospitals, elected officials and others. DCH also solicited input from stakeholders through online surveys and e-mail comments. At the same time, Navigant conducted environmental scans of other states' Medicaid programs; and a complete assessment of the current state of Medicaid in Georgia was completed.

In January 2012, DCH released Navigant's Design Strategy Report, a 400-page document that has served as the basis for decisionmaking regarding the Medicaid and CHIP redesign. Shortly after the report was released, DCH created three stakeholder task forces Aged, Blind and Disabled; Providers; and Children and Families comprised of physicians, hospitals and other health care providers, advocates, caregivers, sister agencies and others. An informal work group focusing on Mental Health & Substance Abuse was formed as well. Each group met multiple times to offer feedback, concerns and recommendations regarding the Redesign Initiative. These groups will continue to meet throughout the procurement and implementation phases of the process.

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The View Ahead -- Coming into Focus

Now that the announcement of improvements and changes to Medicaid has been made, the Georgia Department of Community Health (DCH) plans to move forward with implementation beginning in 2014.
While it is difficult to predict if or when conditions will improve for evaluating more substantial reforms beyond the improvements we have recently announced, the department's work continues with task force and workgroup meetings and more.
Look for Medicaid redesign updates in upcoming issues of DCH-i and visit our website www.dch.georgia.gov. If you would like to share a comment or ask a question, please drop us an e-mail at MyOpinion@dch.ga.gov.

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